Dr. Steven Meixler, right, uses electronic medical records during his examination of patient Meg Warren, 41, of Washingtonville, at the Westchester Medical Group in Harrison Feb. 16, 2007. Andrew Bray, 56, of Haverstraw stands among the shelves of paper files in the medical records department at the Dr. Robert Yeager Health Center in this 2000 photo. / Rory Glaeseman/The Journal News

Written by

Laurie Nikolski

Andrew Bray, 56, of Haverstraw stands among the shelves of paper files in the medical records department at the Dr. Robert Yeager Health Center in this 2000 photo. / Morris J. Kennedy/The Journal News

Health report card

- New Yorker's overall health ranks 25th compared with other states, according to a just-released study, "2008 America's Health Rankings,'' funded by United Healthcare, with detailed analysis by such groups as the American Public Health Association. Find it at www.americashealthrankings.org.On the Web- State Department of Health's Prevention Quality Indicator site: https://apps.nyhealth.gov/statistics/prevention/quality_indicators/- President-elect Barack Obama and Tom Daschle, his choice for secretary of Health and Human Services, are seeking public input to reforming health care at http://change.gov

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Imagine if we had the technology to take a person's blood pressure, temperature, glucose levels and other measurements of health, and use that information to better treat the patient medically. Wait a second - we do. OK, so now imagine if we had the technology to measure and gather in enormous detail not only individual patient data but details about large groups of them. Then imagine using that information to identify patterns and health dangers for all of them; widen access to health care for more people; improve overall care quality; and make prevention and treatment efforts more transparent and public, thereby making providers, and patients themselves, more accountable for better health.

We're getting there, as a nation and in the Lower Hudson Valley.

One important tool to reaching those goals is through EMR: electronic medical records-keeping. The belief in its potential to help reform the American system has grown to such a degree that President-elect Barack Obama has made it a cornerstone of his agenda in the new administration even as the health agenda is evolving. In December, Obama specifically tied an economic recovery plan for the nation to modernizing the health-care system "that won't just save jobs, it will save lives.''

"We will make sure,'' he asserted, "that every doctor's office and hospital in this country is using cutting-edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes and help save billions of dollars each year.'' Obama vowed to spend $50 billion over five years to spur the adoption of electronic health records. His fledgling administration has estimated that "evidence-based medicine'' could eventually save the nation's current $2 trillion-a-year health-care system $80 billion annually.

Around a while

Data-based medicine and electronic records-keeping are not new concepts. President George W. Bush insisted in his January 2004 State of the Union address that "by computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care.'' His goal: Ensure that "most Americans have electronic health records within the next 10 years.'' The effort has had only modest success. The nonprofit Commonwealth Fund issued a report in July that found 98 percent of doctors in the Netherlands and 89 percent in Great Britain use EMR - compared with 28 percent of U.S. physicians. Early last month, slightly better use was reported: Just under 39 percent of U.S. doctors use electronic medical records, the National Center for Health Statistics found; yet only 4 percent of 2,000 doctors questioned said their systems were fully functional.

Nevertheless, the bandwagon gets fuller. In New York City, about 1,000 primary-care physicians are now participating in a $60 million city Health Department project to build a database of detailed patient information "to harness electronic data for public-health goals,'' The New York Times reported Tuesday. The city is using a custom-designed system by a Massachusetts company, eClinicalWorks, and is subsidizing smaller medical practices - 10 or fewer physicians - in order to get the program working.

Meanwhile, under state Health Commissioner Dr. Richard Daines, New York last week unveiled its foray into health-data collection - an online tool that allows New Yorkers to check the prevalence of 12 preventable conditions, such as diabetes, asthma and high blood pressure, in their ZIP code areas. The goal is to allow local health officials, lobbyists and patients to identify serious gaps in prevention and treatment, and refocus efforts and dollars onto prevention and primary care.

"Too many New Yorkers,'' Daines told The Associated Press, "are not getting effective primary care to prevent, detect and treat conditions before they become serious and require hospitalization,'' a very expensive kind of care.

Focus on early intervention

Last fall, Gov. David Paterson announced an investment of $100 million to strengthen and expand the state's primary-care system, lower costs by stopping over-reliance on hospitals and eliminate disparities in health care around the state. It is difficult to do that, though, without reliable data. According to the new state Web site, for example, the hospitalization rate for Hispanics with the 12 chronic conditions is 1.5 times more likely than the statewide average; for black people, the rate is twice as likely. Minorities have long been identified as having higher rates of certain cancers, diabetes and high blood pressure, and poorer access to insurance and disease screenings. Now that information can be known community by community. Reviewing such statistics should force localities, hospitals and other care providers to collaborate on earlier screening and treatment plans, Daines told staff writer Cara Matthews of our Albany Bureau.

Data-driven health care is not merely the substitution of patient paper records with electronic ones called up on a computer screen in an examination room. The traditional medical culture is shifting. Instead of one doctor who may know a patient well providing treatment, physicians and teams of doctors are sharing data and "best practices'' to provide better care, earlier. The shift makes the patient the center of the health-care system, two prominent users of EMR told the Editorial Board last week.

Switching to an electronic medical records system "is the best thing we've ever done,'' said Lindsay Farrell, president and CEO of Open Door Family Medical Centers, which comprises four community health centers and four school-based sites in Westchester. In 2007, Open Door implemented use of eClinicalWorks, which the center's Web site describes as a "unified system for electronic medical records, practice management and document management.'' The system cost more than $1 million, Farrell said; to fund it, the centers used federal, state and private grants. The centers' patient demographics: 98 percent are "low income'' or living in poverty, as defined by the federal government; 50 percent have no health insurance of any kind.

Across the health-care system, Farrell conceded, progress in the use of data-based medicine is "slow.'' For one thing, consensus on what data to collect, share and use is still evolving - and costly. "Physicians with small offices have limited access to capital,'' she said, something an Obama administration could help with.

"Health information can be transformative,'' Farrell said, helping to create a "more robust primary care delivery system in which patients themselves become more activated'' - more involved in their own care - and treatment is a team approach.

Collected data not only "let's you know how you're doing,'' Farrell said, but allows her medical teams to reach out to patients when records indicate they are in need of follow-up care or annual testing, as examples.

Resistance fading

Within the medical field, there was initial resistance to use of EMR as a tool, Farrell said, yet "that has changed pretty quickly the last two years'' - and patients themselves are far more used to it. She likened the change in medical information technology to "banking, pre-ATM, where you used to stand in line to cash a check. Now you do it yourself.'' Likewise, she said, today "doctors and patients have far more personal health information; hopefully, people will become more health literate about their numbers'' - and do something about them.

The Westchester Medical Group has been using comprehensive electronic systems since 2002, Dr. Simeon Schwartz, the group's president, said Wednesday. As the medical environment and the patient population have changed, he said, electronic medical data has added "excitement to medical practice - it's a conduit of care the makes the patient centric to the process.'' The group has 150 physicians at 11 sites in central and lower Westchester, Schwartz said; its data system has 300,000 patient records in it, about 200,000 of which are active.

Schwartz said that a massive switch by large and small health-care providers to EMR is not simply about the cost of gathering data. It requires creating a "structure of medical providers and users who share that information to make it work for improved care,'' such as routinely reaching out to patients who have not had regular mammograms, not just waiting for them to "come in.''

Schwartz estimated information technology for his medical group costs $2.5 million a year, yet has resulted in 175 fewer employees than typical multiple specialty offices like his have. In the end, he said, " we actually save about $8 million a year'' using the technology - and more importantly, provide better care. A down side, he said with a laugh, is that, even as a practicing physician, "I spend about 10 to 15 percent of my week doing IT.''

Information technology, though, represents an essential change in medicine, he said. "In the past,'' he said, "physicians sold knowledge. Physicians now sell wisdom - they have the ability to apply their knowledge based on their experience,'' using the data before them.